Preaching unity and coordination, a small band of high-level hospital group executives has begun meeting in Washington, but their clique is more notable for who hasn't been invited than for who has.
Among the associations participating in the group-which is meeting to plan strategy for what is expected to be a series of very nasty fights next year over Medicare and Medicaid spending, provider-sponsored networks and federal antitrust oversight-are the American Hospital Association (which has provided administrative support and a clubhouse where the group can meet), Premier, VHA and the Catholic Health Association.
The members have specifically moved to exclude the Federation of American Health Systems and its controversial president, Thomas Scully.
The bad blood between Scully and the other hospital lobbyists goes back to last year's Medicare reform and budget battles. At that time, Scully, who has close ties to congressional Republicans, was thought by some hospital groups to be a lone wolf who was not sufficiently willing to fight the Republicans and was too willing to make deals without the consent of his hospital peers.
Publicly, AHA Executive Vice President Richard Pollack downplayed the significance of the new group, which has yet to be given a catchy moniker. (In Washington, this decision is usually hashed out in the first meeting.) Pollack compared the group to other Washington health-related coalitions like the Health Executives Roundtable or the Second Tuesday Breakfast Club. Both of those groups, and several others like them, have membership that extends beyond the hospital community. All meet for the express purpose of coordinating lobbying efforts and sharing information and strategy.
Pollack also denied that the federation, which represents more than 1,400 investor-owned hospitals, was being ostracized.
"It is preposterous to suggest that we are coming together to oppose the federation," Pollack said. "I wouldn't be a part of that."
But the fact remains that Scully and the federation have been excluded, and according to several sources, the reason is personal.
While the Constitution affords even lobbyists the right to associate with whomever they want, the decision gives the appearance of widening the chasm between for-profit and not-for-profit hospitals.
Although no one would talk on the record about the feud, it's clear that some groups still harbor a grudge against Scully.
For his part, Scully acknowledged that he has been on a steep learning curve when it comes to inter-association politics and that he has made mistakes in dealing with other groups. But he also says he has made an effort to work more closely with the other hospital lobbyists. Scully was aware of the new group but declined to comment on the situation.
It appears Scully already may be on the road to redemption. At least one of the members of the new group predicted that by the time the real fighting over the budget begins next year, Scully and several other smaller hospital groups will be included in the meetings. That move may come for several reasons. For one, many of the federation's members, including the biggest, Columbia/HCA Healthcare Corp., also are members of one or more other hospital groups. And second, even the worst critics of Scully, the federation and investor-owned hospitals, agree that they are a strong lobbying force.
The irony of the situation is that everyone involved agrees that closer ties between hospital lobbying organizations will be vital next year when Congress again looks to balance the budget and reform Medicare and Medicaid. Those pending battles have everyone preaching togetherness and coherence.
"We need to maintain some unity in the hospital community, particularly in respect to areas we all agree on," said William Cox, executive vice president of the Catholic Health Association.
Added James Scott, president of the Premier Institute in Washington: "We learned a lesson from last year's provider-sponsored network debate. The insurance companies were better organized. We had a better message but they had better inside-the-Beltway organization. The whole point is we need to be better coordinated and more unified."
"This group is made up of people who have worked together for years, but we still need to be closer, more connected to one another," said Pollack. "There is a benefit to being closer. It will be helpful to do that now because we know it's going to be tough sledding next year."
With the election less than a month away, both sides have really begun to hone their messages on Medicare.
From watching the negative ads that are playing across the nation, it should be clear to everyone that Republicans advocate geriatric genocide by ending Medicare, and Democrats are doing their darndest to bankrupt the program by spending like a bunch of major-league baseball owners. There is ample evidence that both strategies work politically, but there's also evidence that both sides are being economical with the truth.
Specifically, Democrats claim that in a speech to the Blue Cross and Blue Shield Association in Washington last year, House Speaker Newt Gingrich (R-Ga.) said he hoped Medicare would "wither on the vine."
I was at the speech, and that's not what Gingrich said. The irony of Gingrich using such an unlikely Marxist phrase notwithstanding, Gingrich was talking about HCFA withering on the vine, not Medicare.
Gingrich has a way of covering a lot of ground in one sentence, and at the time of the speech there was some confusion about what had been said. But a transcript of the address makes it clear that Gingrich tried to say that a reformed Medicare system would be so attractive to seniors and would create such a perfect market that HCFA no longer would be needed.
The Republican theme is that President Clinton has no plan to stave off the impending bankruptcy of the Medicare Part A trust fund. In fact, the Clinton administration's budget contained a Medicare reform plan not much different from the GOP's plan.
As the debates unfold this month, the candidates will no doubt return to these themes over and over. Buyers should beware.